Health and Social Care Regulation in Wales: An Integrated System of Political, Corporate and Professional Governance for Improving Public Health
Jewel, Tony MBBChir, Ma, Frcgp, Ffph, Wilkinson, Jane Mbbs, Mrcgp, Ffph, The Journal of the Royal Society for the Promotion of Health
Wales is developing a unique integrated system of governance to improve public health, which is diverging from some recent developments in the rest of the UK but shares many common features. There is a focus on strengthening collaborative working and co-ordination between bodies inspecting, regulating and auditing health and social care. Systems are being developed that are proportionate to the level of risk, eliminate unnecessary burdens of external review and support the improvement of services for patients, service users and carers. This is consistent with the Assembly Government's aim to improve the way that public services are delivered in Wales, including strengthening input from the public in the planning, delivery and reporting of regulation and inspection work. The test in the future will be how far we can demonstrate quantitatively and qualitatively the added value from our uniquely Welsh approach, built as it is on devolution and the aspirations for small-country governance.
regulation; health; social care; public health; integrated
Wales achieved devolution in 1999, after nearly 500 years since Wales was incorporated into 'England and Wales' by Henry VIII. Since the establishment of the National Assembly for Wales, the Welsh Assembly Government (WAG) has obtained more legislative powers from parliament following the Government of Wales Act 2006. The direction of travel is towards greater rather than less autonomy. Within Wales there is now a clearer distinction in this third, post- 1999 government between the representative, legislative and scrutiny roles of the National Assembly. There are 60 assembly members (AMs), and Welsh ministers perform the executive function through a cabinet of nine under the leadership of the First Minister. The Welsh ministers are supported in their political leadership and executive role by the WAG civil service, of which we form a part.
This article will set out how the various parts of public health and health and social care governance work in Wales. Some of these derive from the England and Wales reforms during the 1980s and 1990s, while others show how in Wales we are treading a path that is diverging from England and that seeks to demonstrate the benefit of 'smallcountry governance'.
Following the 2007 elections the WAG is led by a coalition between the Labour Party and Plaid Cymru, with a shared commitment to deliver the 'One Wales'1 commitments. The political context described is relevant to any debate about public health governance. In the particular context of Wales, as a nation within the UK, public health governance needs to take account of public and political accountabilities and systems of scrutiny. The devolution settlement for Wales involves areas where the responsibilities are largely devolved, such as health and education, and others where powers are retained by the UK government, such as the treasury and defence. The greatest area of expenditure in utilizing the overall budget of about £14bn is health and social services, which use approximately 40% of the overall resource. Therefore the cabinet, ministers and WAG members and the Welsh media attend closely to the strategic direction and performance in public health, health and social care.
At the WAG level there is less excuse than in Whitehall for silo working either between or within departments, and great opportunities for cross-departmental initiatives. All departmental heads meet weekly as part of the Permanent Secretary's Business Group and also make corporate decisions through a Strategic Delivery and Performance Board. The scale of the small nation is such that external colleagues such as local authority chief executives or NHS chief executives can be called together for face-to-face meetings and for leaders to get to know each other.
Politically the coalition government leans towards democratic participation by the citizen, relying less on market mechanisms and the part consumers play. …